The Implantable Miniature Telescope as a Treatment Option for Individuals With End-Stage Age-Related Macular Degeneration

PURPOSE: Treatment options for individuals with end-stage age-related macular degeneration (AMD) are extremely limited, and no intervention exists that can retard or reverse the characteristic central vision loss. The development of the Implantable Miniature Telescope (IMT; VisionCare, Saratoga, CA) device offers individuals affected by severe functional vision loss an opportunity to enhance some vision within the central visual field. The telescope is implanted in one eye and is used to supplement the impaired central vision, while the remaining eye retains peripheral vision to perform orientation and mobility. Patients who undergo this procedure require extensive vision rehabilitation during which occupational therapists play a pivotal role. The purpose of the concept map was to explore the role occupational therapy plays in the IMT procedure and answer the following focus question: What is the process and benefit of the implantable miniature telescope procedure for individuals with end-stage age-related macular degeneration?

DESIGN: A concept map was used to graphically organize and represent the knowledge related to AMD and the IMT as new treatment option. Inclusion criteria for the journal articles reviewed were publication within the past 10 yr, written in English, and published in a peer-reviewed journal. PubMed, CINAHL, MEDLINE, OTseeker, and PsycINFO were searched with the following key words: telescope, vision loss, aged, and occupational therapy.

METHOD: A concept map approach was selected to produce a visual representation of the knowledge available in order to answer the research focus question. Concept maps are considered a methodological design that can support quantitative and qualitative analysis by creating an awareness of relationships and patterns within the data. A literature search allowed for the identification of key concepts and terms that were rank ordered in terms of relationship to the focus question and its surrounding context. Once key concepts were identified, a preliminary concept map was developed, and cross-links were identified that helped establish relationships between the different segments and domains of knowledge represented on the concept map. Additional review of the preliminary map resulted in further restructuring of the map and tightening of cross-links and the emergence of relationships via additional cross-links.

RESULTS: The concept map clearly indicates that the implantable miniature telescope is a valid and innovative treatment option for individuals with AMD. The device obtained Food and Drug Administration approval in 2005 and is implemented through a four-part treatment process. A benefit of the procedure includes supplemental central field vision within the implanted eye and retention of peripheral vision in the nonimplanted eye to accomplish orientation and mobility tasks. Occupational therapists play a key role on the team of low vision specialists who assist with the treatment program. Preimplantation, low vision occupational therapists evaluate the patient’s expectations and provide education and simulation activities. Postimplantation, they provide essential rehabilitation services to train the patient in how to use the telescope within daily occupational performance.

CONCLUSION: The implantable miniature telescope is a groundbreaking option for individuals with end-stage AMD, who have little or no treatment options. Occupational therapists play a key role in both the preimplantation evaluation and the postimplantation rehabilitation process. Occupational therapy educators and students will benefit from this concept map visual representation to become aware of the disease process of end-stage age-related macular degeneration and this new treatment option.